Varicose vein removal addresses cosmetic issues while preventing more serious problems


Varicose veins, and their milder counterpart, spider veins, are often considered unsightly, but for some they cause far more than cosmetic concern. In addition to pain and discomfort, varicose veins can often be symptomatic of larger issues that will make themselves known if left untreated.

Advanced Nurse Practitioner Ladan Abbasi, a member of The American College of Phlebology who works alongside Dr. Glen Tonnessen, cardiologist and board certified in vascular medicine at The Vein Institute of Hunterdon, said that for most patients with varicose veins heredity is the culprit.

“Eighty to 90 percent of patients have a positive family history,” she noted. “Other factors for women can include multiple pregnancies, hormonal changes, obesity, undiagnosed tumors, or cysts in the pelvis. Heavy lifting, long-time sitting and standing can cause it as well.”

When it comes to the potential risks varicose veins can pose, Abbasi explained that patients are classified across six categories depending on the severity of their conditions. The CEAP (Clinical, Etiologic, Anatomic, Pathophysiologic) classification designates, along with clinical factors, which treatment is most appropriate.

The vascular expert noted that in CEAP 1 typically spider veins are present. These can be addressed if they’re deemed unattractive by the patient but pose no health risk. CEAP 2 patients exhibit varicose veins, while CEAP 3 patients present with leg swelling as well. categories 4, 5 and 6, are more concerning as they reveal evidence of skin changes and ulcerations, which require treatment.

Seeking preventative care in category 3 is the best way to avoid much more invasive and expensive treatment down the road. Abbasi said addressing concerns before they worsen is key.

Fortunately, she said, laser treatments, which typically take less than one hour, have a 98 percent success rate. The process, known as ablation, works by delivering a targeted dose of laser energy directly into the vein wall, causing it to collapse. Following the procedure, patients can expect a bit of bruising or tenderness, which subsides within a few weeks, but are able to return to their regular activities immediately after treatment.

“Prevention is much more cost-effective so it makes sense for patients to seek treatment when they are in CEAP 3 and take care of it early, rather than later on when more treatment is needed and it becomes more expensive and more invasive,” said Abbasi, who speaks from experience. The nurse had two laser procedures in 2014 and said the discomfort wasn’t anything that couldn’t be mitigated by over-the-counter pain relievers.

blogDr.GlenTonnessen.jpgDr. Glen Tonnessen, cardiologist and board certified in vascular medicine at The Vein Institute of Hunterdon.
blogLadanAbbasi.jpgLadan Abbasi, an advanced nurse practitioner and a member of The American College of Phlebology.

Alternatively, patients may opt for sclerotherapy treatment, which involves injecting the problem vein with a solution that irritates the vein lining, causing it to constrict before it eventually is reabsorbed by the body. Blood flow is redirected to other healthier veins that lie beneath the skin’s surface. In time, the injected vein will fade, making it a popular choice for those with both cosmetic and health concerns. The procedure typically takes less than 30 minutes and patients are encouraged to walk to keep blood circulating but are advised to refrain from strenuous exercise for several days following the procedure. Over time, the injected vein will fade. Abbasi said for most patients the most uncomfortable part of the procedure is wearing the compression stockings afterward.

Large, bulging veins are removed through an outpatient procedure known as ambulatory phlebectomy, in which leg veins are removed through tiny, slit-like incisions in the skin. Dr. Tonnessen performs these procedures under local anesthesia so patients feel no pain during the procedure. Typically, little to no discomfort is experience following the procedure. Again, wearing compression stockings as directed will help patients achieve the best results.

“Ambulation is key,” Abbasi said. “Do not sit and baby your leg, don’t stand for a long time either. But the beauty of these procedures is that they’re not disabling. Ninety percent of patients drive themselves home. They can go to the mall or go grocery shopping afterward, they just need to avoid heavy lifting or flying for a few weeks.”

blogVenaCure-EVLT.jpgIn addition to pain and discomfort, varicose veins can often be symptomatic of larger issues. Above, a before (left) and after (right) image of a patient post treatment.

Before any procedures are considered, Abbasi said the professionals at The Vein Institute of Hunterdonevaluate each patient’s complete medical history to determine the best course of treatment.

“Our patients are extremely happy with the results. We recently had a young patient, 32 years old, who was almost crying because she was so pleased with the dramatic improvement,” Abbasi said.

While varicose vein removal was once considered primarily a cosmetic procedure, addressing concerns early can lead to greater comfort and fewer complications down the road.

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